PD11-03 SARCOPENIA CHANGES BEFORE AND AFTER CYSTECTOMY FOR PELVIC RADIATION DISEASE

Timothy W. Hays; Sydney K. Houlton; Bradley A. Erickson

doi:10.1097/01.JU.0001191452.55243.54.03

INTRODUCTION AND OBJECTIVES: Pelvic radiation disease (PRD) can be a devastating complication from rectal, gynecologic and prostate cancer treatments and can necessitate a cystectomy with urinary diversion. We have previously shown that over 90% of these cystectomy patients are deconditioned at the time surgery as demonstrated by psoas muscle thickness per height (PTMH) measurements on CT at surgery consistent with sarcopenia. The purpose of this study was to determine how PTMH changes in the time before and after the operation. METHODS: A retrospective review of patients undergoing cystectomy and diversion for PRD was performed. PMTH (mm/m) was measured from CT scans in 90 patients undergoing urinary diversion surgery following pelvic radiation, excluding patients without pre/post-surgery CT scans. PMTH values were referenced to the scan closest to surgery. A mixed-effects model (REML) with random intercepts by patient examined PMTH versus days before and days after surgery. RESULTS: The cohort included 61 patients (prostate, 37; cervical, 10; rectal, 9; other, 5). Mean PMTH at surgery was 12.24 mm/m in men and 14.26 mm/m in women (range 9.13–22.53). Established normative values showed normal in men and women as ≥17.3 and ≥16.8 mm/m, respectively. Among patients with pre-surgical imaging, 85.1% (n=40) demonstrated PMTH loss prior to surgery, averaging a 13.3% (−2.28 mm/m) decline. Among patients with post-surgical imaging, 81.3% (n=39) exhibited improvement, with an average 18.0% (+2.33 mm/m) increase. Across all patients with pre/post scans, PMTH decreased before surgery (β = −0.48 ± 0.09 mm/m/year) and increased after surgery (β = +0.37 ± 0.09 mm/m/year, both p<0.001). CONCLUSIONS: Sarcopenia is common in PRD patients and appears to worsen in the years leading up to surgery. Treatment of PRD with cystectomy and urinary diversion leads to PMTH improvement. While there are no established criteria about when cystectomy should be offered to PRD patients, these data suggest that delay may lead to worse nutrition status at the time of surgery which is known to affect outcomes. Importantly, successful surgery appears to objectively improve muscle mass, potentially by improving nutrition, physical activity and infection prevention, though further work on urinary diversion benefits is ongoing.

PD11-03 SARCOPENIA CHANGES BEFORE AND AFTER CYSTECTOMY FOR PELVIC RADIATION DISEASE

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